Paper
Wednesday, July 21, 2004
This presentation is part of : Changing Nursing Practice
Changing Team Practice: Applying Evidence-Based Brain Injury Guidelines to Clinical Practice
Mary Kay Bader, RN, MSN, CCRN, CNRN, ED/ICU, ED/ICU, Mission Hospital Regional Medical Center, Mission Viejo, CA, USA
Learning Objective #1: Describe the approach used to analyze the evidence-based literature, plan and implement changes across disciplines, and evaluate outcomes in the severe brain injured population
Learning Objective #2: Translate evidence-based guidelines into the hospital setting with the goal to explore current care practices, contrast the current practice with evidenced-based literature identify opportunities for change, develop new hospital based guidelines, and evaluate the changes in practice
Trauma teams strive to provide care based on best practice. Exploring the clinical outcomes of patients sustaining severe traumatic brain injury (TBI) at our trauma center from 1994-1997 we found the outcomes were marginal at best, 43% expiring and 30% suffering severe disability. These results were consistent with some studies on TBI published in the 1980s. Research in the past decade has utilized new technology for monitoring the effects of secondary brain injury and examined the effects of various treatment modalities on the outcomes of TBI patients. In 1995, evidenced based clinical guidelines for managing severe TBI were published recommending changes in the care of these patients. The guidelines challenged hospitals to evaluate their care practices and examine the clinical outcomes of this high-risk group.

Motivated by the new practice recommendations and the potential for greatly impacting patient outcomes, Mission Hospital’s Neuro CNS convened a multidisciplinary trauma team to begin the process of performance improvement. Current practice was examined and new hospital based clinical guidelines were developed. Numerous changes were recommended as the team dismantled current practice patterns and constructed new care priorities. The result was a series of algorithms with established outcomes at every phase of the patient’s hospital course. Six years after integrating the changes in practice, the team evaluated prospectively collected data to determine outcomes for the severe TBI population. 74% of patients achieved a good outcome to moderate disability, 13% sustained severe disability to persistent vegetative state, and 13% died. This presentation will use a FOCUS-PDCA performance improvement approach to demonstrate the care processes used to apply national clinical guidelines and evidenced based literature to the clinical setting. Statistical analysis using an ordinal regression model will provide outcome data emphasizing the positive aspects of applying evidenced based guidelines to practice.

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Sigma Theta Tau International
July 21, 2004